Provider Demographics
NPI:1740324193
Name:HUDSON, LYDIA MARCIA (DDS)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:MARCIA
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE #110
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4504
Mailing Address - Country:US
Mailing Address - Phone:202-337-5352
Mailing Address - Fax:202-337-1017
Practice Address - Street 1:2500 WISCONSIN AVE NW
Practice Address - Street 2:SUITE #110
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4504
Practice Address - Country:US
Practice Address - Phone:202-337-5352
Practice Address - Fax:202-337-1017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN47121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice